Skip to main content
Download PDF

Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis: a case report and literature review

Infectious Diseases of Poverty volume 9, Article number: 66 (2020) Cite this article

Abstract

Background

Tuberculosis (TB) is a great mimicker and diagnostic chameleon, and prone to be diagnosed as malignancy. Even though many reports have described the differences between pulmonary TB and lung cancer, the atypical systemic hematogenous disseminated TB (HDTB) is very rare and more confusing in clinical practice.

Case presentation

A 73-year-old man, HIV-negative, was hospitalized to the local county hospital because of chest pain, low-grade fever, asthenia, anorexia and weight loss for the pasting two months. The CT findings of the two lungs showed multiple round or round-like nodules of different sizes, with clear boundaries and partial fusion. The level of serum CA19–9 was significantly higher than normal, and progressively increased. There were multiple enlarged lymph nodes in the neck, mediastinum, abdominal cavity and pelvic cavity. The symptoms were diagnosed as hematogenous spread of gastrointestinal tumor in the local county hospital. However, when transferred to our provincial hospital, through comprehensive dynamic analysis, this patient was diagnosed as atypical systemic HDTB, no cancer at all. Through routine anti-TB therapy for one year, the patient was recovered very well at the follow-up of half year after withdrawal.

Conclusions

In the past, most TB misdiagnosis cases involved in single organ and were finally confirmed through invasive examination. This case enriched clinical experiences in the diagnosis of atypical HDTB. We encouraged clinicians to establish a dynamic thinking for diagnosis and treatment and emphasized the value of biopsy and 18F-FDG-PET in distinguishing TB and cancer.

Background

Tuberculosis (TB) is a huge threat for public health in China, which is within the “high-burden country” list [1]. Even though enormous effort has been taken, treatment and control of TB still face many challenges. Detection and diagnosis of Mycobacterium tuberculosis (MTB) is difficult in most case. What’s worse, TB is a great mimicker and diagnostic chameleon, and prone to be diagnosed as malignancy, and vice-versa, because the radiographic characteristics and clinical symptoms of the two diseases are very similar [2,3,4,5]. Since cancer usually has worse prognosis and costs more medical resources compared with TB, misdiagnosis surely increases much more psychological stress and economical burden to the real TB patients. Furthermore, treatment strategy is totally different between neoplasm and TB. In such case, clinicians are placed into a dilemma to make a definite diagnosis, and are even at risk to become a “misdiagnosis murder” [6]. Thus, it’s pivotal to describe and summarize the nuances between neoplasm and TB through more case reports. Here, we described a very unusual case that a 73-year-old immunocompetent man with hematogenous disseminated TB (HDTB) was misdiagnosed as metastasis with multiple organs involvement.

Case presentation

Lung metastasis

On 7 March, 2018, a 73-year-old man, HIV-negative, was hospitalized to the local county hospital for 2-month chest pain, low-grade fever, asthenia, anorexia and weight loss. The patient had history of type II diabetes mellitus with regular administration of gliclazide, but efficacy was poor. Physical examination revealed body temperature 36.7 °C, pulse rate 96 beats/min, blood pressure 133/83 mmHg, respiratory rate 20/min, oxygen saturation 96% and mildly yellow skin and sclera. Respiratory system, cardiovascular system, neurological system and abdomen were normal. Laboratory examination showed anemia (hemoglobin 114 g/L), abnormal liver function (alanine aminotransferase 57 U/L, aspartate aminotransferase 48 U/L, γ-glutamyl transpeptidase 818 U/L, alkaline phosphatase 671 U/L, total bilirubin 44 μmol/L) and elevated cancer antigen 19-9 (CA19-9, 165 U/ml). The interferon-γ release assay test was negative. The skull computerized tomography (CT) showed lacunar infarction in bilateral basal ganglia. The thorax CT revealed multiple round or round-like nodules with variable sizes scattered throughout both lungs, suggestive of metastatic lung disease (Fig. 1A). Abdominal enhancement CT showed that a mass at the pancreatic head was obviously strengthened in the arterial phase, and the pancreatic duct and intrahepatic bile duct was slightly dilated (Fig. 2). Taken together, all examination results were strongly suspected of lung metastasis, which was originated from the pancreatic head or intestinal origin. However, TB infection could not be excluded completely. The patient denied further biopsy, and chose to accept experimental anti-TB therapy with rifampin and isoniazid. After one month, chest CT showed that lung lesions were not absorbed. Laboratory test showed that CA19-9 sharply increased, up to 1167 U/ml. Sputum smear for acid-fast bacilli (AFB) was negative. The doctors in the local county hospital excluded TB infection and proposed gastrointestinal malignant tumors combined with lung metastasis. The patient family was in deep sorrow and prepared to give up.

Fig. 1
figure 1

Thorax CT scan at different time points displayed evolution of lesions. a At admission, the thorax CT revealed multiple round or round-like nodules with variable size scattered throughout both lungs. b Development and evolution of lung lesions. The lung CT scan showed that pulmonary nodules gradually evolved with signs of fibrous tissue hyperplasia, such as cords, long burrs and fusion. c After four months of anti-TB treatment, thorax CT scan showed obvious absorbance of the lung lesions

Full size image
Fig. 2
figure 2

Abdominal enhancement CT suggested lesions in the intestinal tract. a There was a mass at the pancreatic head, indicated by arrow. b Intrahepatic bile duct was dilated, indicated by arrow. c The gallbladder wall (left arrow) and the wall of the upper end of the common bile duct (right arrow) were thicken

Full size image

Hematogenous disseminated TB

On 7 May, 2018, his daughter persuaded the patient to the provincial hospital for further diagnosis. Laboratory examination revealed hyperbilirubinemia (total bilirubin 70 μmol/L), CA19-9 832 U/ml, cancer antigen 125 141 U/ml, neuron-specific enolase 22.98 ng/ml, angiotensin-converting enzyme 178 U/L and serum (1,3)-β-D-glucan 235 pg/ml. 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) scan showed focal high uptake in the multiple organs, including lung, liver, pancreas, spleen, gallbladder neck (Fig. 3), which suggested benign disease (especially TB). The patient accepted the endoscopic retrograde cholangiopancreatography to relieve hyperbilirubinemia, which was caused by bile duct obstruction. Biopsy from brushed biliary cell indicated no malignant tumor. A CT scan-guided transthoracic needle biopsy of the nodule at the left upper lobe was performed and the histopathology showed coagulative necrosis combining with granulomatous inflammation. AFB staining was positive and Periodic Acid-Schiff staining was negative (Fig. 4). In the meanwhile, qPCR for MTB DNA showed 4900 copy/ml in the sputum. Thus, the diagnosis of TB infection was definite. The patient then accepted anti-TB regimen, including isoniazid (300 mg/once a day [QD]), rifampicin (450 mg/QD), ethambutol (750 mg/QD), pyrazinamide (1500 mg/QD), levofloxacin (600 mg/QD) for three months, followed by isoniazid (300 mg/QD) and rifampicin (450 mg/QD) for another nine months.

Fig. 3
figure 3

FDG-PET showed high uptake at different foci. a Foci in the whole body were defined by a circle. The yellow bright spots represented high uptake of 18F-FDG by local tissues. The maximum standard uptake value in different organs were shown, including lung (b, 7.86), liver (c, 5.98), gallbladder neck (d, 11.04), pancreatic head mass (e, 12.54)

Full size image
Fig. 4
figure 4

Puncture biopsy of left lung upper lobe revealed coagulative necrosis combined with granulomatous inflammation with hematoxylin-eosin staining (black arrow). Ziehl-Neelsen staining detected acid-fast bacilli (black circle) and Periodic Acid-Schiff staining was negative. Magnification × 200

Full size image

On 2 September, 2018, almost four months after hospitalization to our hospital, the thorax CT revealed that the lung lesions were absorbed significantly (Fig. 1B). After one year of treatment, continuous clinical and radiological improvement was observed, and the drugs were then withdrawn. The patient was asymptomatic at the follow-up of half year after withdrawal.

Discussion

Characteristics of TB misdiagnosis cases

We conducted literature search in NCBI PubMed database with keywords “tuberculosis” and “cancer” or “tumor” from 2016 to 2019. Totally, 23 hits were retrieved about TB misdiagnosis [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28], including 1 summary analysis and 22 case reports. Half of 22 patients were young adults, with average age under 40. To our interest, none of these 22 patients had underlying diseases at admission except 2 with oncology history, 1 with familial Mediterranean fever, and 1 just subjected to kidney transplantation. It’s noted that 15 (68.2%) of the 22 cases involved in single organ, with lung the most involved organ (54.5%). Of the 22 cases, 19 (86.4%) were confirmed by invasive examination, like biopsy of the lesion. In summary, the clinical manifestations of some TB cases are non-specific, which are most likely misdiagnosed as tumor.

Differences of pulmonary modules between lung metastasis and HDTB

Pulmonary nodules refer to the round intrapulmonary lesions with less than 3 cm in diameter [29]. Multiple nodules in the lung are one of the most common clinical imaging presentations, which appear in a variety of diseases, such as lymphangitis carcinomatosa, silicosis, and bronchioloalveolar carcinoma [30]. In particular, multiple small pulmonary nodules are frequently observed in both lung metastasis and HDTB [31, 32]. Besides, some chronic inflammation and unusual lymphoma involving in the lungs, could also display multiple pulmonary nodules [33]. The imaging manifestations of those diseases are so similar that a definite diagnosis is difficult to make [34]. The differences of nodule characteristics between lung metastasis and HDTB are summarized in Table 1. In our case, lung CT showed multiple round nodules of different size, with clear boundaries and partial fusion. Abdominal CT showed slight dilatation of intrahepatic bile duct and pancreas, enlargement of pancreatic head, multiple low-density foci in spleen.

Table 1 Comparison of nodule characteristics between lung metastasis and hematogenous disseminated tuberculosis
Full size table

Nonspecificity of CA19-9

CA19-9 level was significantly higher than normal, and progressively increased. It is known that, CA19-9 is synthesized by pancreatic and biliary ductal cells, as well as gastric, colon, endometrial and salivary epithelia. Only small amount of CA19-9 is present in serum [39]. CA19-9 is considered as the marker for pancreatic cancer in clinical practice. However, this indicator has the disadvantage of low specificity [39, 40]. Overexpression of CA19-9 was observed in several benign gastrointestinal disorders, which may be relevant to glycan mediated cell-cell interactions in mucosal immunity [40]. Additionally, higher level of CA19-9 was found in the pancreatic tuberculosis [41, 42]. In our case, sharply increased CA19-9 also played a role of misleading.

Clues to make definite diagnosis

When we looked into these symptoms with comprehensive dynamic analysis, we found that this patient had anemia and his white blood cells was not high, indicating that he was in the course of chronic infection (our clinical experience). There were multiple pulmonary nodules, most of which distributed along with the bronchovascular bundle. Some nodules were not very regular. Pulmonary nodules in the upper lung showed a trend of enlargement, fusion and infiltration. In addition, signs of fibrous hyperplasia such as strips and long burrs appeared in the process of evolution (Fig. 1C). We gradually thought it was more likely to be inflammatory granuloma lesions, instead of malignant tumor. At the other hand, abdominal CT suggested thickening of the gallbladder wall and uniform thickening of the upper-end wall of the common bile duct. Although the head of the pancreas was enlarged, it still had regular shape, clear boundary, and consistent enhancement with the whole pancreas body. All these signs also suggested chronic inflammation. Additionally, in this case, the maximum standard uptake value (SUVmax) of PET CT imaging for pulmonary nodules was 7.86, located between 2.65 and 10.9, which probably indicated benign lesions. The value of PET CT in evaluating the efficacy of TB treatment, especially extrapulmonary TB, has been widely recognized [23]. Unfortunately, given its high cost, it cannot be widely used in China at present. The patient also refused to accept re-examination by PET CT for this reason. Otherwise, the effect of individualized chemotherapy regimen can be better evaluated through the changes in pathological metabolism. Finally, puncture biopsy of lung confirmed pulmonary TB. Through anti-TB treatment, the patient was cure, which in turn supported our diagnosis.

Conclusions

The patient turned out to be atypical systemic HDTB, not cancer at all. Such atypical HDTB was relatively rare in clinical practice. We encouraged clinicians to keep dynamic thinking of the disease in mind and know more special signs of rare diseases.

Availability of data and materials

Data relating to this study are contained and presented in this document. Other materials are available from the corresponding authors on reasonable request.

Abbreviations

TB:

Tuberculosis

MTB:

Mycobacterium tuberculosis

HDTB:

Hematogenous disseminated TB

CT:

Computerized tomography

AFB:

Acid-fast bacilli

18F-FDG-PET:

18F-fluorodeoxyglucose positron-emission tomography

QD:

Once a day

References

  1. World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organization. 2019, Licence: CC BY-NC-SA 3.0 IGO.

  2. Fijołek J, Wiatr E, Polubiec-Kownacka M, Błasińska-Przerwa K, Szołkowska M, Szczepulska-Wójcik E, et al. Pulmonary tuberculosis mimicking lung cancer progression after 10 years of cancer remission. Adv Respir Med. 2018;86(2):92–6. https://doi.org/10.5603/ARM.2018.0012.

    Article  PubMed  Google Scholar 

  3. Ko Y, Mo E-K, Park YB, Kang M-R, Bae JS, Kim Y. Miliary Tuberculosis mimicking brain metastasis from renal cell carcinoma. J Neurocrit Care. 2018;11(1):47–53. https://doi.org/10.18700/jnc.180045.

  4. Lang S, Sun J, Wang X, Xiao Y, Wang J, Zhang M, et al. Asymptomatic pulmonary tuberculosis mimicking lung cancer on imaging: a retrospective study. Exp Ther Med. 2017;14(3):2180–8. https://doi.org/10.3892/etm.2017.4737.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Singh VK, Chandra S, Kumar S, Pangtey G, Mohan A, Guleria R. A common medical error: lung cancer misdiagnosed as sputum negative tuberculosis. Asian Pac J Cancer Prev. 2009;10(3):335–8. 19640168.

  6. Vaghasiya K, Sharma A, Verma R. Misdiagnosis murder: Disguised TB or lung cancer? Pulmon Res Respir Med. 2016;3:e5-6. https://doi.org/10.17140/PRRMOJ-3-e006.

  7. Chamberlin K, Orfanos S, Mukherjee A, Moy E, Koganti M, Khan W. A case of disseminated tuberculosis mimicking metastatic cancer. Respir Med Case Rep. 2018;25:239–41. https://doi.org/10.1016/j.rmcr.2018.10.001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Morikawa K, Misumi S, Fukuda T. A case of pulmonary tuberculosis with multiple nodules mimicking lung metastases. BJR Case Rep. 2019;5(3):20180124. https://doi.org/10.1259/bjrcr.20180124.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kawaratani H, Moriya K, Ishida K, Noguchi R, Namisaki T, Takaya H, et al. Cecal tuberculosis mimicking submucosal tumor. Cecal tuberculosis mimicking submucosal tumor. Intern Med. 2016;55(14):1859–63. https://doi.org/10.2169/internalmedicine.55.5139.

    Article  PubMed  Google Scholar 

  10. Pintos-Pascual I. Cervix tuberculosis simulating cancer. Cecal tuberculosis mimicking submucosal tumor. Intern Med. 2016;55(14):1859–63. https://doi.org/10.2169/internalmedicine.55.5139.

    Article  Google Scholar 

  11. Ciftci F, Shimbori N, Karnak D. Concurrent central nervous system and endobronchial tuberculosis mimicking a metastatic lung cancer. Clin Respir J. 2017;11(1):98–102. https://doi.org/10.1111/crj.12311.

    Article  PubMed  Google Scholar 

  12. Ando M, Mukai Y, Ushijima RI, Shioyama Y, Umeki K, Okada F, et al. Disseminated mycobacterium tuberculosis infection masquerading as metastasis after heavy ion radiotherapy for prostate Cancer. Intern Med. 2016;55(22):3387–92. https://doi.org/10.2169/internalmedicine.55.7039.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Voit FM, Abdelhafez M, Rothe K, Slotta-Huspenina J, Gaa J, Schmid RM, et al. Disseminated tuberculosis mimicking metastatic gastric cancer-a case report. Z Gastroenterol. 2019;57(12):1487–92. https://doi.org/10.1055/a-1030-4781.

    Article  PubMed  Google Scholar 

  14. Hajjar W, Ahmed I, Aljetaily S, Al-Obaidan T, Hajjar AW. Endobronchial tuberculosis simulating carcinoid tumor. J Coll Physicians Surg Pak. 2018;28(3):S39-41. https://doi.org/10.29271/jcpsp.2018.03.S39.

  15. Di Giovanni SE, Cunha TM, Duarte AL, Alves I. Endometrial tuberculosis simulating an ovarian cancer: a case report. Acta Med Port. 2016;29(6):412–5. https://doi.org/10.20344/amp.7706.

  16. Wang H, Qu X, Liu X, Ding L, Yue Y. Female peritoneal tuberculosis with ascites, pelvic mass, or elevated CA 125 mimicking advanced ovarian cancer: A retrospective study of 26 cases. J Coll Physicians Surg Pak. 2019;29(6):588–9. https://doi.org/10.29271/jcpsp.2019.06.588.

  17. Gera K, Kishore N. Image diagnosis. Endobronchial tuberculosis masquerading as an Endobronchial tumor with presentation as middle lobe syndrome. Perm J. 2017;21:16–006. https://doi.org/10.7812/TPP/16-006.

    Article  PubMed  Google Scholar 

  18. Sassalos TM, Rao RC, Demirci H. Ocular tuberculosis masquerading as a tumor. Lancet Infect Dis. 2018;18(8):924. https://doi.org/10.1016/S1473-3099(18)30123-3.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Daoudi M, Herrak L, Ftouh ME, Achachi L. [Pseudotumoral bronchopulmonary tuberculosis mimicking cancer in an immunocompetent patient]. Pan Afr Med J. 2019;32:170. doi:https://doi.org/10.11604/pamj.2019.32.170.18129.

  20. Moukit M, Fadel FA, Kouach J, Babahabib A, Dehayni M, Rahali DM. Pseudo-tumoral peritoneal tuberculosis mimicking ovarian cancer: an important differential diagnosis to consider. Pan Afr Med J. 2016;25:193. https://doi.org/10.11604/pamj.2016.25.193.10929.

  21. Pilaniya V, Gera K, Kunal S, Shah A. Pulmonary tuberculosis masquerading as metastatic lung disease. Eur Respir Rev. 2016;25(139):97–8. https://doi.org/10.1183/16000617.00002315.

    Article  PubMed  Google Scholar 

  22. Nowakowska-Arendt A, Jagiełło G. Pulmonary tuberculosis mimicking numerous lung metastases—a case study. Med Res J. 2018;3(1):43–6. https://doi.org/10.5603/MRJ.2018.0008.

  23. Yates JA, Collis OA, Sueblinvong T, Collis TK. Red snappers and red herrings: pelvic tuberculosis causing elevated CA 125 and mimicking advanced ovarian cancer. A case report and literature review. Hawaii J Med Public Health. 2017;76(8):220–4. 28808611.

    PubMed  PubMed Central  Google Scholar 

  24. Schmidt-Lauber C, Jacobi J, Polifka I, Hilgers KF, Wiesener MS. Suspected colonic cancer turns out to be disseminated tuberculosis in a kidney transplant recipient: a case report. Medicine (Baltimore). 2019;98(36):e16995. https://doi.org/10.1097/MD.0000000000016995.

    Article  Google Scholar 

  25. Lan C-C, Wu C-W, Wu Y-K. Systemic tuberculosis mimicking lung Cancer with multiple metastases. Am J Med Sci. 2020;359(3):186–7. https://doi.org/10.1016/j.amjms.2019.09.006.

    Article  PubMed  Google Scholar 

  26. Rodpenpear N. Tuberculosis of cervix resembling cervical Cancer. J Med Assoc Thail. 2016;99(Suppl 8):S249–52. 29906057.

    Google Scholar 

  27. Vamsi Krishna S, Mallikarjunaswamy B, Issac T, Srinivasalu S. Tuberculosis of knee joint mimicking giant cell tumor-a case report. Indian J Tuberc. 2018;65(3):260–1. https://doi.org/10.1016/j.ijtb.2016.09.021.

    Article  PubMed  Google Scholar 

  28. Sellami M, Mnejja M, Charfi S, Ghorbel A. Tuberculosis of the tonsil simulating a cancer. Lancet Infect Dis. 2017;17(12):1317. https://doi.org/10.1016/S1473-3099(17)30315-8.

    Article  PubMed  Google Scholar 

  29. Setio AAA, Traverso A, De Bel T, Berens MS, van den Bogaard C, Cerello P, et al. Validation, comparison, and combination of algorithms for automatic detection of pulmonary nodules in computed tomography images: the LUNA16 challenge. Med Image Anal. 2017;42:1–13. https://doi.org/10.1016/j.media.2017.06.015.

    Article  PubMed  Google Scholar 

  30. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner society 2017. Radiology. 2017;284(1):228–43. https://doi.org/10.1148/radiol.2017161659.

  31. Dursun P, Ersoz S, Gultekin M, Aksan G, Yüce K. Ayhan A. Disseminated peritoneal tuberculosis mimicking advanced-stage endodermal sinus tumor: a case report. 2006;16(Suppl 1):303–7. https://doi.org/10.1111/j.1525-1438.2006.00205.x.

    Article  Google Scholar 

  32. Falagas M, Kouranos V, Athanassa Z, Kopterides P. Tuberculosis and malignancy. QJM. 2010;103(7):461–87. https://doi.org/10.1093/qjmed/hcq068.

    Article  CAS  PubMed  Google Scholar 

  33. Denning DW, Page ID, Chakaya J, Jabeen K, Jude CM, Cornet M, et al. Case definition of chronic pulmonary aspergillosis in resource-constrained settings. Emerg Infect Dis. 2018;24(8):e171312. https://doi.org/10.3201/eid2408.171312.

    Article  PubMed Central  Google Scholar 

  34. Onuigbo WI. Some nineteenth century ideas on links between tuberculous and cancerous diseases of the lung. Br J Dis Chest. 1975;69:207–10. https://doi.org/10.1016/0007-0971(75)90081-9.

    Article  CAS  PubMed  Google Scholar 

  35. Aquino SL. Imaging of metastatic disease to the thorax. Radiol Clin N Am. 2005;43(3):481–95. https://doi.org/10.1016/j.rcl.2005.02.006.

    Article  PubMed  Google Scholar 

  36. Kawaguchi K, Taniguchi T, Fukui T, Nakamura S, Yokoi K. Radiological findings and surgical outcomes of pulmonary metastases originating from biliary tract carcinoma. Gen Thorac Cardiovasc Surg. 2019;67(11):962–8. https://doi.org/10.1007/s11748-019-01122-6.

    Article  PubMed  Google Scholar 

  37. Khan F. Review of literature on disseminated tuberculosis with emphasis on the focused diagnostic workup. J Family Community Med. 2019;26(2):83–91. https://doi.org/10.4103/jfcm.JFCM_106_18.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chierakul N, Boonsuk J, Muangman N, Totanarungroj K. Radiographic features for predicting smear-negative pulmonary tuberculosis. J Med Assoc Thail. 2016;99(6):697–701.

    Google Scholar 

  39. Scarà S, Bottoni P, Scatena R. CA 19-9: biochemical and clinical aspects. Adv Exp Med Biol. 2015;867:247–60. https://doi.org/10.1007/978-94-017-7215-0_15.

    Article  CAS  PubMed  Google Scholar 

  40. Pavai S, Yap S. The clinical significance of elevated levels of serum CA 19-9. Med J Malaysia. 2003;58(5):667–72.

    CAS  PubMed  Google Scholar 

  41. Bhatia V, Garg PK, Arora VK, Sharma R. Isolated pancreatic tuberculosis mimicking intraductal pancreatic mucinous tumor. Gastrointest Endosc. 2008;68(3):610–1. https://doi.org/10.1016/j.gie.2007.12.022.

    Article  PubMed  Google Scholar 

  42. Yang Y-J, Li Y-X, Liu X-Q, Yang M, Liu K. Pancreatic tuberculosis mimicking pancreatic carcinoma during anti-tuberculosis therapy: A case report. World J Clin Cases. 2014;2(5):167–169. doi: https://doi.org/10.12998/wjcc.v2.i5.167.

Download references

Acknowledgements

Not applicable.

Funding

This work was supported by Natural Science Foundation of Jiangsu province (Grant No. BK20170133) and social development project of key research and development plan of Jiangsu province (Grant No. BE2018606).

Author information

Authors and Affiliations

  1. Department of Tuberculosis, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou District, Nanjing, Jiangsu Province, 210003, China

    Tian-Xing Hang, Gang Fang, Yan Huang & Chun-Mei Hu

  2. Clinical Research Center, the Second Hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou District, Nanjing, Jiangsu Province, 210003, China

    Wei Chen

Authors
  1. Tian-Xing Hang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gang Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chun-Mei Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TXH and GF conducted the literature review and wrote the draft. YH collected clinical data. CMH and WC conceived the study and revised the manuscript. The author(s) read and approved the final manuscript.

Corresponding authors

Correspondence to Chun-Mei Hu or Wei Chen.

Ethics declarations

Ethics approval and consent to participate

Written consent was exempted by the institutional review boards of the Second Hospital of Nanjing, since no identifying images or other personal information were included.

Consent for publication

All authors have read and approved the manuscript.

Competing interests

The authors declare that they have no competing interests.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hang, TX., Fang, G., Huang, Y. et al. Misdiagnosis of a multi-organ involvement hematogenous disseminated tuberculosis as metastasis: a case report and literature review. Infect Dis Poverty 9, 66 (2020). https://doi.org/10.1186/s40249-020-00681-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40249-020-00681-8

Keywords

  • Misdiagnosis
  • Hematogenous disseminated tuberculosis
  • Metastasis
  • Pulmonary nodule

Infectious Diseases of Poverty

ISSN: 2049-9957

Contact us